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Bednarek L, Glover S, Ma X, Pittenger C, Pushkarskaya H. Externally orienting cues improve cognitive control in OCD. J Behav Ther Exp Psychiatry 2024; 84:101959. [PMID: 38531125 PMCID: PMC11192454 DOI: 10.1016/j.jbtep.2024.101959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/31/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVES An executive overload model of obsessive-compulsive disorder (OCD) posits that broad difficulties with executive functioning in OCD result from an overload on the executive system by obsessive thoughts. It implies that, if individuals with OCD "snap out" of their obsessive thoughts, their performance on neurocognitive tasks will improve. METHODS We test this prediction using the revised Attention Network Test, ANT-R, and distinct subsamples of data from unmedicated OCD and healthy controls (HC). ANT-R includes Simon and Flanker tasks; in both, incongruent trials take longer to resolve ('conflict costs'). On some trials, a warning cue helps participants to respond faster ('alerting benefits'). In OCD (N = 34) and HC (N = 46), matched on age, IQ, and sex, we tested (1) the effect of OCD on alerting benefits, and (2) the effect of OCD on warning cue related reductions in conflict costs. In a distinct subsample of OCD (N = 32) and HC (N = 51), we assessed whether alerting benefits and cue-related reductions in conflict costs are associated differently with different OCD symptoms. RESULTS A warning cue can help individuals with OCD more than HC to improve performance on Simon and Flanker tasks. This effect is positively associated with severity of contamination symptoms. LIMITATIONS This study did not directly assess how distracted participants are by obsessive thoughts. It relied on the ANT-R subtraction measures. Symptom severity was assessed using self-report measures. CONCLUSIONS Difficulties in resolving conflict during decision-making in OCD can be modulated by a warning cue presented immediately before an attentional task.
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Affiliation(s)
- Lora Bednarek
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Stephanie Glover
- PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, United States
| | - Xiao Ma
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; Department of Psychology, Yale University, New Haven, CT, United States; Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States; Wu Tsai Institute, Yale University, New Haven, CT, United States; Yale Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT, United States
| | - Helen Pushkarskaya
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
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Cooper DDJ, Wong SF, Grisham JR. Testing an Imagery Rescripting Exercise Targeting Fear of Self. J Cogn Psychother 2024; 38:243-254. [PMID: 38991739 DOI: 10.1891/jcp-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
A feared possible self refers to the unwanted characteristics that a person may possess or develop. We tested an experimental paradigm to target fear of possible self using imagery rescripting. A student sample (n = 91), with moderate obsessive-compulsive disorder symptoms, engaged in written and audio-guided exercises to evoke episodic future mental imagery that represented their feared possible self. Participants were then randomized between imagery rescripting or neutral imagery control tasks. The results revealed no difference between conditions in fear of self or general obsessional beliefs following the manipulation. State anxiety and the urge to neutralize the imagery reduced more in the control condition than in the rescripting condition. These findings suggest that the current paradigm is emotionally engaging but not effective at addressing fear of self as measured. Methodological improvements such as removing a written component of the rescripting task and idiosyncratic measuring of fear of self are proposed.
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Affiliation(s)
- David D J Cooper
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Shiu Fung Wong
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Jessica R Grisham
- School of Psychology, The University of New South Wales, Sydney, Australia
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Tempia Valenta S, Campanile G, Albert U, Marcolini F, Faedi G, De Ronchi D, Atti AR. Beyond the surface: Understanding obsessive symptoms and body perceptions, from shape concerns to fear of blushing. Compr Psychiatry 2024; 132:152481. [PMID: 38552348 DOI: 10.1016/j.comppsych.2024.152481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Recent reclassifications have expanded the understanding of Obsessive-Compulsive Disorders (OCDs), now incorporated into a broader category known as Obsessive-Compulsive Disorder and Related Disorders (OCRDs). This study sought to assess obsessive-compulsive symptoms and body uneasiness among outpatients seeking treatment for Eating Disorders (ED). Additionally, we aimed to explore associations and potential mediation effects between obsessive-compulsive symptoms and body uneasiness. This investigation extended beyond concerns related solely to body shape and weight, encompassing fears associated with specific body components (such as facial features, abdominal region, and limbs) or functions (including sweating, blushing, emitting noises, and releasing odors). METHODS Psychometric assessments included the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Body Uneasiness Test (BUT). Statistical analyses involved bivariate correlations, linear regression, and mediation analysis to explore the associations and potential mediation effects between obsessive-compulsive symptoms and different manifestations of body uneasiness. RESULTS The sample (N = 210) demonstrated substantial obsessive-compulsive symptoms and notable body discomfort. OCI-R scores positively correlated with various dimensions of body dissatisfaction, including shape, weight, and specific body components or functions. Linear regression revealed significant associations between OCI-R scores and overall body uneasiness (BUT-A) as well as concerns about body components or functions (BUTB). Mediation analysis indicated that BUT-A mediated the relationship between obsessive-compulsive symptoms and BUTB. CONCLUSION This study offers new insights into the comprehensive landscape of OCRDs. It specifically emphasizes the association between obsessive-compulsive symptoms and body uneasiness, embracing not only concerns about body shape and weight but also extending to body components and functions.
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Affiliation(s)
- S Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - G Campanile
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - U Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - F Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Faedi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - D De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - A R Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Xu J, Ironside ML, Broos HC, Johnson SL, Timpano KR. Urged to feel certain again: The role of emotion-related impulsivity on the relationships between intolerance of uncertainty and OCD symptom severity. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:258-272. [PMID: 38351642 PMCID: PMC11104491 DOI: 10.1111/bjc.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 01/22/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Obsessive-compulsive disorder (OCD) is a debilitating mental disorder characterized by persistent and intrusive thoughts accompanied by repetitive mental or physical acts. While both intolerance of uncertainty and emotion-related impulsivity have been consistently evidenced as cognitive risk factors of OCD, no studies have considered their joint effects. The current study examined the interaction between intolerance of uncertainty and two forms of emotion-related impulsivity-including both a behavioural and cognitive form-in predicting OCD symptoms. DESIGN Cross-sectional data were collected online from community-based adult participants. METHODS Participants (N = 673) completed a battery of self-report measures of OCD symptom severity, intolerance of uncertainty, and emotion-related impulsivity. RESULTS The behavioural form of emotion-related impulsivity positively moderated the relationship between intolerance of uncertainty and OCD symptoms. Elevated levels of both factors predicted the most severe symptoms, particularly checking, washing, and obsessing. This interaction effect was not found for the cognitive form of emotion-related impulsivity, which still emerged as a unique predictor of OCD symptom severity, specifically obsessing symptoms. CONCLUSIONS Current findings furthered the understanding of the link between intolerance of uncertainty and OCD symptoms by highlighting the role of emotion-related impulsivity. When uncertainty triggers distress in individuals with high intolerance of uncertainty, the urge to behaviourally alleviate this distress could promote the use of maladaptive obsessions and compulsions, leading to greater OCD symptoms. Results also indicated the potentially differential effects from the behavioural versus cognitive forms of emotion-related impulsivity on different symptom domains, and the mechanistic link here is worthy of further investigation.
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Affiliation(s)
- Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital
- University of California, Berkeley
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Huynh PA, Miles S, de Boer K, Meyer D, Nedeljkovic M. A systematic review and meta-analysis of the relationship between obsessive-compulsive symptoms and symptoms of proposed orthorexia nervosa: The contribution of assessments. EUROPEAN EATING DISORDERS REVIEW 2024; 32:257-280. [PMID: 37838984 DOI: 10.1002/erv.3041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to update the literature on orthorexia nervosa (ON), a proposed diagnosis of pathologically 'healthy' eating, by critically analysing the current evidence for the relationship between ON and obsessive-compulsive (OC) symptoms. Further, this paper aimed to compare the ON/OC relationship significance and strength based on when the ON measurement tool was developed. METHOD PsycINFO, PubMed and Web of Science databases were queried for quantitative, peer-reviewed studies recruiting adult participants, published in English up to April 2023. Studies not directly comparing ON and OC symptoms were excluded. After full-text review and quality assessment, 40 studies were included in the systematic review and 31 studies in the meta-analysis. RESULTS ON assessments created prior to the 2016 revised ON diagnostic criteria do not appear to fully capture OC symptoms. Studies using earlier developed ON assessments demonstrated inconsistent ON/OC relationships whereas studies implementing more recent assessments (from 2018 onwards) found consistently significant, larger relationships, highlighting a previously underrated OC component of ON. CONCLUSIONS Early ON studies, and studies utilising early ON assessments should be interpreted with caution, particularly in relation to OC symptom involvement in ON. Future research should validate novel ON assessments and investigate common underlying factors.
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Affiliation(s)
- Phillipa Ann Huynh
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephanie Miles
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, Melbourne, Victoria, Australia
| | - Kathleen de Boer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Denny Meyer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
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Abramovitch A, Uwadiale A, Robinson A. A randomized clinical trial of a gamified app for the treatment of perfectionism. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:73-91. [PMID: 37864496 DOI: 10.1111/bjc.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES Perfectionism is a common transdiagnostic problem that may lead to substantial distress and functional impairments. Cognitive behavioural therapy (CBT) is an effective treatment for perfectionism. However, the existing significant barriers to access and utilization of mental health services, including among college students, demand the development of low-intensity accessible interventions. The aim of the present study was to evaluate the effectiveness of a low-intensity CBT-based self-help gamified app developed specifically for perfectionism in a sample of college students. METHODS Participants completed assessments of perfectionism, related symptoms, emotional burden and functional impairments at pretreatment, posttreatment and at one-month follow-up. RESULTS Compared with the waitlist condition (n = 35), the app condition (n = 35) demonstrated a significant and greater reduction in perfectionism, obsessive-compulsive symptoms, functional impairments and subjective ratings of emotional burden. CONCLUSIONS Results suggest that a brief, daily app-based game-like intervention targeting maladaptive perfectionistic beliefs may be a viable, low-cost alternative to traditional CBT treatments for vulnerable populations on college campuses.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Akuekegbe Uwadiale
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Holmberg A, Martinsson L, Lidin M, Rück C, Mataix-Cols D, Fernández de la Cruz L. General somatic health and lifestyle habits in individuals with obsessive- compulsive disorder: an international survey. BMC Psychiatry 2024; 24:98. [PMID: 38317127 PMCID: PMC10840209 DOI: 10.1186/s12888-024-05566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has been associated with a broad range of health-related issues. Unhealthy lifestyle habits such as physical inactivity, an unhealthy diet, smoking, and alcohol consumption are hypothesized to contribute to this association. However, the lifestyle habits of individuals with OCD have been scarcely investigated. In this international survey, we explored the physical health and lifestyle habits of adults with a self-reported diagnosis of OCD. METHODS An online global survey available in seven languages was disseminated through interest organizations and social media between July 2021 and March 2022. The survey included questions relating to socio-demographic variables and clinical characteristics (including OCD symptom severity - as measured with the 12-item self-report scale Obsessive-Compulsive Inventory [OCI-12] - and psychotropic medication), physical health, and lifestyle habits. Frequencies and percentages, or means and standard deviations, as appropriate, were calculated. Subgroup analyses by OCD symptom severity, gender, and age group were performed. RESULTS A total of 496 individuals with OCD completed the survey and were included in the analyses (mean age = 36.0 years, SD = 12.5, range 18-79; 78.8% women). Most participants were from Europe (n = 245, 49.4%) and North America (n = 187, 37.7%). OCD symptom severity scores were on the moderate range (OCI-12 mean score = 21.2, SD = 9.1). A majority (n = 354, 71.4%) reported having comorbid somatic health issues, mainly allergies, gastrointestinal conditions, and cardiometabolic conditions. Nearly half of the sample (n = 236, 47.6%) reported a body mass index ≥ 25, corresponding to at least overweight. A significant proportion of the participants reported low physical activity (n = 271, 55.0%), unhealthy dietary habits (n = 182, 36.7%), risk consumption of alcohol (n = 111, 22.3%), and non-restorative sleep (n = 268, 54.0%). Subgroup analyses showed overall similar results across groups, with some exceptions. CONCLUSIONS In this sample, individuals with OCD self-reported a range of health-related issues and a number of unhealthy lifestyle behaviors, most prominently a lack of physical activity. Interventions aimed at modifying unhealthy lifestyles to prevent or improve health conditions beyond the psychiatric symptoms should be considered.
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Affiliation(s)
- Anna Holmberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Lina Martinsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Matthias Lidin
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Nováková L, Anýž J, Forejtová Z, Rošíková T, Věchetová G, Sojka P, Růžička E, Serranová T. Increased Frequency of Self-Reported Obsessive-Compulsive Symptoms in Patients with Functional Movement Disorders. Mov Disord Clin Pract 2023; 10:1341-1348. [PMID: 37772279 PMCID: PMC10525059 DOI: 10.1002/mdc3.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/06/2023] [Accepted: 05/29/2023] [Indexed: 09/30/2023] Open
Abstract
Background Functional movement disorders (FMD) are associated with a high prevalence of psychiatric comorbidities. Objective To assess the frequency of obsessive-compulsive symptoms (OCS) in FMD. Methods A total of 167 consecutive patients with clinically definite FMD (mean age = 44.4 years, standard deviation [SD] = 12.0, 119 females) and 145 healthy controls (mean age = 43.2 years, SD = 11.8, 103 females) completed the Obsessive-Compulsive Inventory-Revised (OCI-R), which is a widely used tool for assessing OCS. The cutoff score ≥21 is indicative of clinically significant obsessive-compulsive disorder (OCD). Motor symptom severity was assessed using the Simplified FMD Rating Scale (S-FMDRS). All subjects completed questionnaires for depression, anxiety, pain, fatigue, cognitive complaints, health-related quality of life, and childhood trauma. Personality traits were assessed using the Big Five questionnaire. Results FMD patients had higher mean OCI-R score and higher proportion of individuals with OCI-R ≥ 21 42%, 95% confidence interval (CI) = (30.2, 54.6) versus 16%, 95% CI = (8.2, 28.2) in controls, P < 0.001. Patients had higher scores in three domains: checking, ordering, and obsessing (P < 0.001). FMD patients with OCI-R score ≥21 had higher depression, anxiety, cognitive complaints, and lower quality of life compared to those with score <21 (P < 0.001). No correlation between OCI-R and S-FMDRS scores was found. Conclusions FMD patients reported higher rates of OCS compared to controls, along with higher rates of non-motor symptoms and lower quality of life. This finding may have clinical implications and raises the possibility of shared risk factors and common pathophysiological mechanisms in FMD and OCD.
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Affiliation(s)
- Lucia Nováková
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, 1st Faculty of Medicine and General University Hospital in PraguePragueCzech Republic
| | - Jiří Anýž
- Department of Cybernetics, Faculty of Electrical EngineeringCzech Technical University in PraguePragueCzech Republic
| | - Zuzana Forejtová
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, 1st Faculty of Medicine and General University Hospital in PraguePragueCzech Republic
| | - Tereza Rošíková
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, 1st Faculty of Medicine and General University Hospital in PraguePragueCzech Republic
| | - Gabriela Věchetová
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, 1st Faculty of Medicine and General University Hospital in PraguePragueCzech Republic
| | - Petr Sojka
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, 1st Faculty of Medicine and General University Hospital in PraguePragueCzech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, 1st Faculty of Medicine and General University Hospital in PraguePragueCzech Republic
| | - Tereza Serranová
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, 1st Faculty of Medicine and General University Hospital in PraguePragueCzech Republic
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Cooper SE, Hunt C, Stasik-O'Brien SM, Berg H, Lissek S, Watson D, Krueger RF. The Placement of Obsessive-Compulsive Symptoms Within a Five-Factor Model of Maladaptive Personality. Assessment 2023; 30:891-906. [PMID: 35098736 DOI: 10.1177/10731911211070623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dimensional models of obsessive-compulsive (OC) symptoms, as seen in obsessive-compulsive disorder (OCD), are instrumental in explaining the heterogeneity observed in this condition and for informing cutting-edge assessments. Prior structural work in this area finds that OC symptoms cross-load under both Negative Affectivity and Psychoticism traits within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model of Personality Disorder (AMPD). However, tests of OC symptoms in conjunction with assessments of the full AMPD structure and its 25 lower-level facets representing narrower symptom content are lacking. We applied joint exploratory factor analysis to an AMPD measure (Personality Inventory for DSM-5; PID-5) and OC symptom data from two separate samples (total N = 1,506) to locate OC symptoms within AMPD space. OC symptoms cross-loaded on Negative Affectivity, Psychoticism, and on the low end of Disinhibition. We also report exploratory analyses of OC symptom subscales with PID-5 variables. Results are discussed in the context OC symptoms' location in PID-5 space, implications for assessment, and placement of OCD within the Hierarchical Taxonomy of Psychopathology.
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Affiliation(s)
| | | | | | - Hannah Berg
- University of Minnesota Twin Cities, MN, USA
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10
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Patrick AK, Ramsey KA, Essoe JKY, McGuire JF. Clinical Considerations for an Evidence-Based Assessment for Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:17-38. [PMID: 36740351 DOI: 10.1016/j.psc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is an impairing mental health disease, generally beginning in childhood, affecting up to ∼3% of the population. Using evidence-based assessments (EBAs) is the starting point for the accurate diagnosis and treatment of OCD. EBAs consist of structured and semistructured clinician-administered interviews, parent-report and child-report, and self-report for adults. This article details the practical application, psychometric properties, and limitations of available assessments to determine the presence of OCD and evaluate OCD symptom severity. The following reviews measurement of constructs relevant to OCD (ie, insight, family accommodation, impairment) and details considerations for best clinical interview practices.
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Affiliation(s)
- Ainsley K Patrick
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 550 North Broadway, Baltimore, MD 21224, USA; Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children, Johns Hopkins University School of Medicine, 550 North Broadway, Suite 206, Baltimore, MD 21205, USA
| | - Kesley A Ramsey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 550 North Broadway, Baltimore, MD 21224, USA; Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children, Johns Hopkins University School of Medicine, 550 North Broadway, Suite 206, Baltimore, MD 21205, USA
| | - Joey K-Y Essoe
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 550 North Broadway, Baltimore, MD 21224, USA; Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children, Johns Hopkins University School of Medicine, 550 North Broadway, Suite 206, Baltimore, MD 21205, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 550 North Broadway, Baltimore, MD 21224, USA; Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children, Johns Hopkins University School of Medicine, 550 North Broadway, Suite 206, Baltimore, MD 21205, USA.
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Flygare O, Wallert J, Chen LL, Fernández de la Cruz L, Lundström L, Mataix-Cols D, Rück C, Andersson E. Empirically Defining Treatment Response and Remission in Obsessive-Compulsive Disorder Using the Obsessive-Compulsive Inventory-Revised. Behav Ther 2023; 54:43-50. [PMID: 36608976 DOI: 10.1016/j.beth.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
In clinical trials of obsessive-compulsive disorder (OCD), clinical outcomes are generally measured using lengthy clinician-administered interviews. However, in routine clinical practice, many clinicians lack the time to administer such instruments. This study evaluated cutoffs for treatment response and remission in OCD using the self-rated Obsessive-Compulsive Inventory-Revised (OCI-R). Data from 349 patients in three clinical trials of cognitive-behavioral therapy for OCD were pooled for analysis. The OCI-R was compared to gold-standard criteria for response and remission based on the clinician-administered Yale-Brown Obsessive Compulsive Scale and the Clinical Global Impression Scale. The results showed that a ≥40% reduction on the OCI-R was the optimal cutoff for treatment response, with a sensitivity of 0.72 and a specificity of 0.79. For remission status, the optimal cutoff was ≤8 points on the OCI-R, with a sensitivity of 0.57 and specificity of 0.83. Results from additional analyses using the 12-item version of the OCI were similar. These cutoffs provide a simple and time-efficient way to help determine treatment response and remission in OCD when the administration of clinician-administered instruments is unfeasible.
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Affiliation(s)
- Oskar Flygare
- Karolinska Institutet and Stockholm Health Care Services.
| | - John Wallert
- Karolinska Institutet and Stockholm Health Care Services
| | - Long-Long Chen
- Karolinska Institutet and Stockholm Health Care Services
| | | | - Lina Lundström
- Karolinska Institutet and Stockholm Health Care Services
| | | | - Christian Rück
- Karolinska Institutet and Stockholm Health Care Services
| | - Erik Andersson
- Karolinska Institutet and Stockholm Health Care Services
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12
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Psychometric Properties of Malay Obsessive-compulsive Inventory-child Version (OCI-CV) in Malaysian Perspectives. Scand J Child Adolesc Psychiatr Psychol 2022; 10:114-122. [PMID: 36514488 PMCID: PMC9716882 DOI: 10.2478/sjcapp-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background This study aimed to examine the psychometric properties of reliability and validity of OCI-CV in a non-clinical sample of Malaysian children and adolescents. Method Participants of school-age and adolescent students from Klang Valley School completed the 21-item Malay OCI-CV using Google Form. OCI-CV English version was translated backward and forward to the Malay language. Face validity was conducted first before distributing the questionnaire to the participants. Exploratory Factor analysis (EFA) and Confirmatory Factor Analysis (CFA) was conducted to evaluate the psychometric properties of OCI-CV. Results A total of 102 school-age children and adolescents with a mean age of 15.96 years (male: 41.2%, female: 58.8%) participated in the study. The Malay OCI-CV showed high internal consistency, with Cronbach Alpha values of 0.90 for the whole scale. EFA showed multifactorial components. Five factors were labelled as "Washing / Ordering, Doubting, Obsessions, Checking, and Hoarding,". In the CFA, the five-factor model indicates adequate fit indices of (χ2/df = 1.51, RMSEA = .071, GFI = .824, AGFI = .769, NFI = .724, CFI = .880). Conclusion The Malay OCI-CV has good psychometric properties and is suitable for use in the Malaysian context. Further validation studies should be conducted among a clinical population to enhance the generalization of this finding.
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Hallit S, Azzi V, Malaeb D, Obeid S. Any overlap between orthorexia nervosa and obsessive-compulsive disorder in Lebanese adults? Results of a cross-sectional study and validation of the 12-item and 4-item obsessive-compulsive inventory (OCI-12 and OCI-4). BMC Psychiatry 2022; 22:470. [PMID: 35836242 PMCID: PMC9282139 DOI: 10.1186/s12888-022-04119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Orthorexia Nervosa (ON), a compulsive obsession with vigorous eating, has increasingly caught researchers' attention. Although Orthorexia Nervosa has not been labeled an eating disorder, research about ON highlighted a strong link with anorexia nervosa or obsessive-compulsive disorder (OCD). Therefore, this study aimed to (1) validate the Arabic version of the Obsession-Compulsion Inventory (OCI-12 and OCI-4) and (2) check if there is an overlap between ON and OCD among a sample of Lebanese adults. METHODS This cross-sectional study involved 487 Lebanese participants between July and August 2021. The Dusseldorf Orthorexia Scale (DOS) was used to assess ON; scores between 25 and 29 indicate probable ON, whereas scores ≥ 30 indicate ON tendencies. A confirmatory factor analysis (CFA) was carried out using SPSS AMOS v.24 on the OCI-12 and OCI-4 scales' items. The root mean square error of approximation (RMSEA) statistic, the Tucker Lewis Index (TLI) and the comparative fit index (CFI) were used to evaluate the goodness-of-fit of the model. RESULTS The CFA results indicated an excellent fit of the model: the Maximum Likelihood Chi-Square = 147.73 and Degrees of Freedom = 48, which gave a χ2/df = 3.08, TLI = 0.934, CFI = 0.952, and RMSEA = 0.065 [95% CI 0.054-0.078]. The fit indices of the one-factor structure of the OCI-4 were excellent as well: χ2/df = 6.15/2 = 3.08, TLI = 0.95, CFI = 0.98 and RMSEA = 0.065 [95% CI 0.007-0.127]. The Area Under the Curve was 0.600 [95% CI 0.524-0.674]. There was no cutoff value that showed good sensitivity or specificity at the same time. At the DOS cutoff of 25, sensitivity was 19.1%, whereas the specificity was 90.6%. The positive and negative predictive values (PPV and NPV) at this cutoff value were 24.4% and 88.7% respectively. At the DOS cutoff of 30, sensitivity was 8.8%, whereas the specificity was 94.3%. The PPV and NPV at this cutoff value were 10.6% and 92.5% respectively. The results showed that higher total OCD scores (Beta = 0.15) were significantly associated with more ON tendencies. Moreover, higher OCD washing scores (Beta = 0.52), physical activity index (Beta = 0.06), and Body Mass Index (Beta = 0.17) were significantly associated with more ON tendencies. CONCLUSION The present results suggest that ON, as measured by the DOS, shares more common features with disordered eating and cannot adequately predict the presence of OCD symptoms.
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Affiliation(s)
- Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Vanessa Azzi
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Diana Malaeb
- grid.411884.00000 0004 1762 9788School of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates ,grid.444421.30000 0004 0417 6142School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sahar Obeid
- grid.411323.60000 0001 2324 5973Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
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The OCI-CV-R: A Revision of the Obsessive-Compulsive Inventory - Child Version. J Anxiety Disord 2022; 86:102532. [PMID: 35091252 PMCID: PMC8961678 DOI: 10.1016/j.janxdis.2022.102532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Obsessive-Compulsive Inventory-Children's Version (OCI-CV) was developed to assess obsessive-compulsive symptoms in youth. Recent changes in the Diagnostic and Statistical Manual (DSM-5) exclude hoarding from inclusion in the diagnosis of obsessive-compulsive disorder (OCD). Accordingly, the present study examined the reliability, validity, factorial structure, and diagnostic sensitivity of a revised version of the scale - the OCI-CV-R- that excludes items assessing hoarding. METHODS Participant were 1047 youth, including 489 meeting DSM criteria for primary OCD, 298 clinical controls, and 260 nonclinical controls, who completed the OCI-CV and measures of obsessive-compulsive symptom severity, depression, and anxiety at various treatment and research centers. RESULTS Findings support a five-factor structure (doubting/checking, obsessing, washing, ordering, and neutralizing), with a higher order factor. Factorial invariance was found for older (12-17 years) and younger (7-11 years) children. Internal consistency of the OCI-CV-R was acceptable, and discriminant and convergent validity were adequate and akin to that of its progenitor. Diagnostic sensitivity and specificity were found for a total score of 8 and higher. CONCLUSION It is recommended that the OCI-CV-R replace the former version, and that this measure serve as part of a comprehensive clinical assessment of youth with OCD. Recommendations for further research with ethnically and racially diverse samples, as well as the need to establish benchmark scores are discussed.
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Ramakrishnan S, Robbins TW, Zmigrod L. Cognitive Rigidity, Habitual Tendencies, and Obsessive-Compulsive Symptoms: Individual Differences and Compensatory Interactions. Front Psychiatry 2022; 13:865896. [PMID: 35573321 PMCID: PMC9094714 DOI: 10.3389/fpsyt.2022.865896] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Recent theories have posited a range of cognitive risk factors for obsessive-compulsive disorder (OCD), including cognitive inflexibility and a maladaptive reliance on habits. However, empirical and methodological inconsistencies have obscured the understanding of whether inflexibility and habitual tendencies indeed shape OCD symptoms in clinical and sub-clinical populations, and whether there are notable interactions amongst these traits. The present investigation adopted an interactionist individual differences approach to examine the associations between behaviorally-assessed cognitive flexibility and subclinical OCD symptomatology in a healthy population. It also explored the nature of the interactions between cognitive flexibility and habitual tendencies, and the degree to which these cognitive traits predict subclinical OCD symptomatology. Across two studies, including a preregistration, Bayesian and regression analyses revealed that cognitive inflexibility and compulsive habitual tendencies act as unique and independent predictors of subclinical OCD symptomatology in healthy populations. Furthermore, there was a significant interaction between cognitive rigidity and habitual compulsivity, which accounted for 49.4% of the variance in subclinical OCD symptomatology in Study 1, and 37.3% in Study 2. In-depth analyses revealed a compensatory effect between cognitive inflexibility and habitual compulsivity such that both are necessary for OCD symptomatology, but neither is sufficient. These results imply that in order to generate reliable and nuanced models of the endophenotype of OCD symptomatology, it is essential to account for interactions between psychological traits. Moreover, the present findings have important implications for theories on the cognitive roots of OCD, and potentially in the development of interventions that target both cognitive inflexibility and habitual compulsivity.
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Affiliation(s)
- Smriti Ramakrishnan
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Leor Zmigrod
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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Randazza MP, McKay D, Bakhshaie J, Storch EA, Zvolensky MJ. Unhealthy Alcohol Use Associated with Obsessive-Compulsive Symptoms: The Moderating Effects of Anxiety and Depression. J Obsessive Compuls Relat Disord 2022; 32:100713. [PMID: 35242506 PMCID: PMC8887883 DOI: 10.1016/j.jocrd.2022.100713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol use occurs among individuals with obsessive-compulsive symptoms at a rate significantly greater than the general population. In clinical populations, obsessive-compulsive disorder (OCD) and substance use disorders (SUD) have been shown to share neurological substrates, but little is known about the mechanisms underlying substance use in individuals with OCD. Aspects of anxiety and depression frequently contribute to various SUD and are thought to play a role in the relationship between increased substance use and obsessive-compulsive symptomatology. The present research examines the moderating effects of depression and several anxiety-related constructs (anxious arousal, anxiety sensitivity, and social anxiety) on the relationship between health risk resulting from alcohol use and obsessive-compulsive symptoms in university students (n = 178). The physical concerns and social concerns subscales of the Anxiety Sensitivity Index increased the relationship between risky drinking and total OCD symptoms (as measured with the OCI-12). Additionally, general depression and social anxiety significantly increased the relationship between risky alcohol use and the obsessing dimension. All relationships were of a small to medium effect size. These findings help identify emotionally vulnerable subgroups of persons with OCD that may have greater liability for risky alcohol use.
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Affiliation(s)
- Michael P. Randazza
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
| | - Dean McKay
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
| | - Jafar Bakhshaie
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| | - Eric A. Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Houston, TX 77204, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Houston, TX 77030, USA
- HEALTH Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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Hesitancy to Return to the Pre-pandemic Routine. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022; 40:23-39. [PMID: 33967389 PMCID: PMC8094127 DOI: 10.1007/s10942-021-00396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 01/07/2023]
Abstract
The goal of the present study was to explore COVID-19 related hesitancy, which represents the inability of people to return to previous levels of functioning after a major medical crisis like the current pandemic. A new questionnaire was developed to evaluate participants' hesitancy. The study was conducted online in November, 2020, using convenience sampling. A total of 538 individuals from the general Greek population participated in the study and completed the Hesitancy Questionnaire, the Generalized Anxiety Disorder 2-item (GAD-2), the Short Health Anxiety Inventory and a COVID-19-related worry question. The Hesitancy Questionnaire proved to have adequate psychometric properties. Correlation with anxiety as assessed by GAD-2 proved to be significant but low, indicating that the two scales are measuring two different concepts. The greatest hesitancy was observed in older adults for both genders (males, M = 40.86, SD = 15.24; females, M = 49.34, SD = 14.74). Women in general appeared more hesitant than men scoring higher (males, M = 36.13, SD = 15.25; females, M = 42.63, SD = 17.31) with a statistically significant difference [t(536) = - 3.706, p = .001). This study provided a tool to informed understanding on how citizens perceive the new normality after the COVID-19 pandemic. If not appropriately addressed, hesitancy may increase stress levels and result in mental health or socialization problems.
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